Manage the Mental Side of Skin Disorders
By Bianca Nogrady
Nonpharmacologic interventions such as psychotherapy, hypnosis, and meditation can
offer significant benefits to patients with dermatologic conditions including psoriasis,
eczema, and urticaria, according to Dr. Richard G. Fried.
While the use of nonpharmacologic interventions may seem counterintuitive, these therapies
have been shown to improve psychosocial function and reduce the negative emotional states that
can exacerbate or even elicit skin disease, said Dr. Fried of Yardley (Pa.) Dermatology
Associates. Dr. Fried detailed several strategies and options for managing the mental aspect of
skin disorders in an article in the June issue of Seminars in Cutaneous Medicine and Surgery.
“Clinical studies have demonstrated that psychological stress disrupts skin barrier function and
increases the severity of cutaneous infections, and down-regulates antimicrobial peptide
expression, resulting in more severe skin infections in mice,” Dr. Fried wrote.
“This self-perpetuating negative interaction between stress and impaired skin function has been
well-described and often underlies the so-called ‘vicious cycle’ that exists between skin and
negative emotional states,” he said.
Dr. Fried proposed three broad categories of ‘psychocutaneous’ patients. First, there are
individuals with skin manifestations associated a psychiatric diagnosis such as depression,
anxiety, or body dysmorphic disorder.
The second category includes patients with psych-derm conditions such as acne excoriée,
neurotic excoriations, dermatitis artefacta, and trichotillomania. The third category covers
patients with common skin conditions such as acne, rosacea, psoriasis, eczema, and urticaria that
are known to be impacted by emotional factors.
Dr. Fried suggested that even patients dealing with the dermatologic effects of aging may be at
risk for negative emotional sequelae and may benefit from nonpharmacologic interventions.
Hypnosis is one intervention that has been shown to benefit some patients. For example,
long-lasting effects of hypnosis (particularly in highly hypnotizable patients) may include
reduced scratching in eczema, and can aid resolution of acne excoriée.
“Recent studies in patients with alopecia areata (including several with ophiasis distribution)
demonstrated that hypnosis promotes excellent regrowth in approximately 50% of treated
patients and improvements in depression and anxiety in almost all patients,” Dr. Fried reported.
Cognitive-behavioral psychotherapy is one of several common psychotherapy interventions used
to treat the psychological aspects of skin disorders. Data from a 6-week study of cognitive-
behavioral therapy in psoriasis patients showed improvements in anxiety, depression, and
psoriasis-related stress, compared with patients who didn’t receive the therapy. In addition, the
psychotherapy intervention group showed three times the clinical improvement, compared those
undergoing conventional treatment without therapy.
Group psychotherapy has also been associated with symptom reduction, decreased pruritus,
fewer eczema relapses, and decreased steroid use in patients with eczema who used it to
supplement to their regular medication.practiced in a less formal manner by ]dermatologists themselves, Dr. Fried said.
“The power to heal by words, manner, and touch cannot be overstated. Gentle, compassionate,
and optimistic comments and gestures can affect the physiology, emotional well-being, and compliance of our patients,” he said.